South Africa, 21 November 2013: In South Africa, centre works with vulnerable adolescents to prevent HIV/AIDS infection

The Centre for the AIDS Programme of Research in South Africa (CAPRISA) supports a comprehensive programme of HIV prevention, treatment, care and support in Vulindlela, a rural community fighting high rates of HIV/AIDS.

By Guy Hubbard

On 29 November, UNICEF releases Children and AIDS: Sixth Stocktaking Report, the first report of its kind since 2010.

An AIDS-free generation once seemed like a far-off dream. But, now, the world has what it takes to make this dream a reality. Advancements in preventing mother-to-child transmission of HIV have greatly decelerated the rate of new infections in babies in low- and middle-income countries. However, the same progress has not been seen in treatment for children living with HIV, and the trajectory of AIDS deaths among adolescents living with HIV remains alarming.

One centre in South Africa is focusing on vulnerable adolescents at the epicentre of the country’s HIV/AIDS epidemic – and infection rates are dropping.

VULINDLELA, South Africa, 21 November 2013 – With one of the highest infection rates in the country, Vulindlela – a rural community in Kwazulu Natal Province – is at the epicentre of South Africa’s HIV/AIDS epidemic.

“We used to witness 8, 10, maybe 12 funerals a day,” says community leader and counsellor Gethwana Mahlase. “I cannot forget the day that the men had to distribute themselves – ‘Who's going to go and dig this grave? Who's going to go and dig that grave?’ – because there were so many that were dying.”

Zandile, 19, participates in a CAPRISA support group where adolescents living with or without HIV can safely open up to one another and freely discuss issues surrounding sex, gender and HIV/AIDS.

In the absence of HIV testing and antiretroviral treatment, AIDS killed young women and men, leaving children to be raised by their grandparents. “We had so many orphans,” explains Ms. Mahlase, “because it was mainly the young people that were dying.”

CAPRISA

Things began to change when the Centre for the AIDS Programme of Research in South Africa (CAPRISA) opened a clinic and research facility in the community in 2001. Through a comprehensive programme of HIV prevention, treatment, care and support, the centre was able to start saving lives.

“CAPRISA has a phenomenal, innovative approach,” explains Dr. Ayesha Kharsany, Senior Scientist at CAPRISA. “What we aspire to do is to understand the epidemic … [so that] we are able to tailor our responses.”

And through research, a portrait of lingering vulnerability started to emerge. “When we look at how we prevent new HIV infections and … where those new infections are occurring, we know that we have to work with adolescents,” says Dr. Kharsany.

The area has an unemployment rate of nearly 70 per cent, and the lack of opportunity leaves many youths with little hope for the future. Some girls say that they turn to older men for support – for financial security.

Peer educator Terrence Mayisela, 21, encourages adolescent boys to get tested for HIV and to volunteer for medical circumcision. The procedure can significantly reduce the risk of HIV infection.

At age 17, Zandile Mabhida saw promise in one such relationship and left school to marry. But the relationship soon turned abusive, and she eventually fled, leaving behind the son she had borne.

“I started smoking and drinking because I missed my child so much,” says Zandile, now 19. “But then I met Gethwana [Mahlase] … I joined her group and shared my problems with others who were sharing their problems.”

The support group provides a safe environment where adolescents can open up to one another – discussing their past and their hopes for the future, as well as issues surrounding sex, gender and HIV/AIDS.

By working with community leaders like Ms. Mahlase, CAPRISA is able to stay in touch with shifts in the epidemic and in the adolescent population, gaining knowledge that enables optimal mixing and matching of interventions to prevent new infections.

Peers preventing HIV/AIDS

CAPRISA has also recruited football players in the community to work as peer educators. Idolized by many youths, these footballers are ideally placed to give advice on how to prevent HIV/AIDS.

Peer counsellor Terrence Mayisela, 21, is one of them. Terrence underwent voluntary medical male circumcision at the encouragement of his mother, an HIV counsellor, and started encouraging other members of his football team to do the same. Voluntary medical male circumcision has been shown to reduce the risk of heterosexually acquired HIV infection in men by approximately 60 per cent.

Now, he encourages adolescent boys to get tested for HIV and to volunteer for the procedure.

According to Terrence, “[C]ircumcision is a short pain period. But, when you’re not circumcised, you can get HIV easily, and you live with it for the rest of your life.”

Some adolescents remain reluctant, but his efforts are working: Every Saturday, as many as 100 adolescent boys recruited by Terrence and his fellow peer educators arrive at a CAPRISA clinic to undergo the procedure.

And there is evidence that CAPRISA is starting to have an impact of its own. The target of eliminating new infections in Vulindlela is still a long way off, but through research, innovation and partnership with the community, infection rates are dropping – and those living with HIV are surviving.